(NaturalNews) Big Pharma drug reps were once a fixture in doctor's offices and hospitals but their influence on American doctors has waned significantly over the past decade. More and more physicians eschew face-to-face contact with drug reps in favor of seeking information about new medications online through pharma-sponsored sites, third-party websites or by reading evidence-based reviews of new medications.

Other factors have contributed to their declining influence as well, such as a push by the healthcare industry to have doctors prescribe more generic, and thereby less expensive, medications.

So it should come as no surprise that Big Pharma, increasingly shut out of pushing the more lucrative medications in the United States, would find other markets in other countries in which to pimp their wares.

One of those emerging markets is India, where Big Pharma sales reps are allowed to offer doctors all kinds of goodies - coffee makers, a vacuum cleaner or perhaps some cookware - in order to get them to prescribe the companies' drugs, Reuters reported recently.

Abbott guide lists the gifts to be handed out

Such gifts are just a few of the many offered to Indian physicians, according to an Abbott sales-strategy guide for the second quarter of 2011. As stated in no uncertain terms in the guide, doctors who agree to prescribe Abbott's brand-name drugs, or those who have already prescribed a certain amount, "can expect some of these items in return," the Reuters report said.

The guide, for example, contains an entry for the medication Nupod, an Abbott antibiotic that is known generically as cefpodoxime. As an incentive for doctors to prescribe it, the guide lists a medical textbook, a mosquito repellant and a coffee maker that reps can offer.

The guide also provides a sales script containing verbiage that will ostensibly help seal the quid pro quo: "Dr. presenting you advanced coffee maker from Philips which will make coffee within three minutes ... Dr. in the box we have made advancement easy for you by giving the ideal usage guidelines of the coffee maker ... Dr. I look forward for advancement in action i.e. our Nupod brand ... Dr. can get just three Rx per day for Nupod."

One Abbott rep who spoke off the record said that, especially in India's poorer regions, "if you give [a doctor] a small gift, they are happy."

A larger problem

The Abbott guide, which reps say the company regularly produces, is a sign of a much wider issue in India. Reuters interviewed scores of doctors, drug reps and other healthcare insiders who said, essentially, that domestic and international pharmaceutical companies rain extras on Indian doctors, including gifts, extravagant excursions abroad and cash payments that are said to be consultancy fees, as well as others.

Industry insiders call the system "Indian CRM," or customer-relationship management. It should be noted that none of the physicians or drug reps would speak on the record for the story.

The biggest reason, most likely, is that, under Indian law, doctors are not permitted to accept cash, travel or gifts from drug makers. But enforcement of the law is rare, so drug companies shower gifts on Indian physicians with impunity, even though their home nations may punish the practice.

'Somebody is doing something for you'

And in a nation where some doctors often make less than $10,000 a year, it's seen as an effective drug-pushing strategy.

"Somebody is doing something for you," one Delhi-based cardiologist said. "Obviously you will want to return the favor."

He went on to tell Reuters that he prescribed additional medications from companies that hand out gifts and send him on paid vacations to places like Thailand, Hong Kong and elsewhere.

In the U.S., meanwhile, "hospitals now restrict promotional sales calls, keep tabs on when and where reps go and do not allow them unfettered access to trainees," says the American Medical Association. "Resident physicians are sequestered, so to speak, learning only about evidence-based science and drug information and unexposed to pharma's literature and personnel advocating costly, newly minted and brand-name drugs."